Healthcare Provider Details

I. General information

NPI: 1972526861
Provider Name (Legal Business Name): ADVANTAGE DIABETIC AND MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N FLORIDA ST
MOBILE AL
36607-3009
US

IV. Provider business mailing address

107 N FLORIDA ST
MOBILE AL
36607-3009
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-2238
  • Fax: 251-661-2177
Mailing address:
  • Phone: 251-661-2238
  • Fax: 251-661-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number595
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANNE S WEAVER
Title or Position: PRESIDENT
Credential:
Phone: 251-661-2238